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Encopresis
DSM-III In DSM-III, this disorder is called Functional Encopresis Diagnostic Criteria A'''. Repeated voluntary or involuntary passage of feces or normal or near-normal consistency into places not appropriate for that purpose in the individual's own sociocultural setting. '''B. At least one such event a month after the age of four. C'''. Not due to a physical disorder, such as aganglionic megacolon. '''Differential Diagnosis Functional Encopresis must be differentiated from structural organic causes of encopresis, such as aganglionic megacolon and anal fissure, which need to be ruled out by physical examination. DSM-IV Diagnostic Criteria A'''. Repeated passage of feces into inappropriate places (e.g., clothing or floor) whether involuntary or intentional. '''B. At least one such event a month for at least 3 months. C'''. Chronological age is at least 4 years (or equivalent developmental level). '''D. The behavior is not due exclusively to the direct physiological effects of a substance (e.g., laxatives) or a general medical condition except through a mechanism involving constipation. Specify as follows: * With Constipation and Overflow Incontinence * Without Constipation and Overflow Incontinence Subtypes Encopresis is specified according to the subtype that characterizes the presentation: With Constipation and Overflow Incontinence There is evidence of constipation on physical examination or by history. Feces are characteristically (but not invariably) poorly formed and leakage is continuous, occurring both during the day and during sleep. Only small amounts of feces are passed during toiletting, and the incontinence resolves after treatment of the constipation. Without Constipation and Overflow Incontinence There is no evidence of constipation on physical examination or by history. Feces are likely to be of normal form and consistency, and soiling is intermittent. Feces may be deposited in a prominent location. This is usually assocaited with the presence of Oppositional Defiant Disorder or Conduct Disorder or may be the consequence of anal masturbation. Differential Diagnosis General medical condition A diagnosis of Encopresis in the presence of a general medical condition is appropriate only if the mechanism involves constipation. Fecal incontinence related to other general medical conditions (e.g., chronic diarrhea) would not warrant a DSM-IV diagnosis of Encopresis. DSM-5 Diagnostic Criteria A'''. Repeated passage of feces into inappropriate places (e.g., clothing, floor), whether involuntary or intentional. '''B. at least one such event occurs each month for at least 3 months. C'''. Chronological age is at least 4 years (or equivalent developmental level). '''D. The behavior is not attributable to the physiological effects of a substance (e.g., laxatives) or another medical condition except through a mechanism involving constipation. Specify whether: * With constipation and overflow incontinence: There is evidence of constipation on physical examination or by history. * Without constipation and overflow incontinence: There is no evidence of constipation on physical examination or by history. Subtypes Feces in the with constipation and overflow incontinence subtype are characteristically (but not invariably) poorly formed, and leakage can be infrequent to continuous, occurring mostly during the day and rarely during sleep. Only part of the feces is passed during toileting, and the incontinence resolves after treatment of the constipation. In the without constipation and overflow incontinence subtype, feces are likely to be of normal form and consistency, and soiling is intermittent. Feces may be deposited in a prominent location. This is usually associated with the presence of oppositional defiant disorder or conduct disorder or may be the consequence of anal masturbation. Soiling without constipation appears to be less common than soiling with constipation. Differential Diagnosis A diagnosis of encopresis in the presence of another medical condition is appropriate only if the mechanism involves constipation that cannot be explained by other medical conditions. Fecal incontinence related to other medical conditions (e.g., chronic diarrhea, spina bifida, anal stenosis) would not warrant a DSM-5 diagnosis of encopresis.